Outcome of Initial Antibiotic Treatments among Hospitalized Patients with Hospital- and Healthcare-Associated Bacterial Infections in Brazil: Findings of the RECOMMEND Study

Background: In recent years, increased rates of multidrug-resistant (MDR) Gram-negative bacterial infections have been observed globally. Recent real-world data documenting first-line treatments and associated clinical outcomes are lacking. This study assessed outcomes associated with initial antibiotic treatments in hospitalized patients with nosocomial pneumonia (NP), complicated urinary tract infections (cUTI) and intra-abdominal infections (cIAI) in Brazil.  

Methods: This was a retrospective observational study (NCT02364284) involving medical chart review of adults hospitalized with one of the three infections across 4 sites in Brazil. The study period was from July 1, 2013 to June 30, 2014. Patients were followed from index date until death while hospitalized, up to 30-days post discharge, or the end of follow-up period (December 2014) if not yet discharged. Initial antibiotic treatment (IAT), defined as the antibiotics received during the 48 hours post-therapy initiation, and associated outcome (success, failure, and indeterminate) were assessed. MDR was defined as exhibiting resistance to one drug in at least three antibiotic classes. Study data were documented using descriptive measures. 

Results: The study included 82 patients with cUTI (mean age: 58 years; females: 59%), 89 patients with cIAI (mean age: 58 years; females: 52%), and 100 patients with NP (mean age: 65 years; females: 25%). Proportion of patients with an MDR infection was 36% for patients with cUTI, 22% for cIAI and 27% for NP. IAT as monotherapy was observed in 79% of cUTI patients, 54% of cIAI patients, and 68% of NP patients. The two most commonly observed IATs for the three infection types are presented in Figure 1. Reasons for stopping the IAT are presented in Figure 2. The overall IAT failure rate for cUTI, cIAI and NP were 74%, 79% and 90% respectively. In-hospital all-cause mortality rates for were cUTI, cIAI and NP were 46%, 56% and 72% respectively.

Conclusion: High rates of IAT failure and all-cause mortality highlight an unmet need among hospitalized patients with common hospital-acquired or healthcare-associated Gram-negative infections. Limitations associated with an observational study should be considered when interpreting these results.